Racial/Ethnic Disparities Persist among U.S. Children with Perinatal HIV Infection

		SUMMARY: While the rate of mother-to-child HIV transmission in the U.S. has fallen by about 90% since the widespread adoption of testing during pregnancy and zidovudine (AZT, Retrovir) prophylaxis, marked racial/ethnic disparities remain, researchers from the Centers for Disease Control and Prevention (CDC) reported in the February 5, 2010 Morbidity and Mortality Weekly Report. During 2004-2007, nearly 70% of perinatal infections occurred among black children -- a rate of 12.3 per 100,000 compared with only 0.5 per 100,000 among whites.

By Liz Highleyman

Racial/ethnic differences in the burden of HIV/AIDS among adults and children have been apparent since the earliest years of the epidemic. During 1981-1986, more than 75% of children with AIDS were black/African-American or Hispanic/Latino.

To characterize the most recent trends in diagnoses of perinatal HIV infection by race/ethnicity, Margaret Lampe and colleagues from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention analyzed national HIV surveillance data for the period 2004-2007 (the latest data available) from 34 states with consistent name-based reporting.

Perinatal infection was assumed in cases where HIV infection was diagnosed in children younger than 13 years of age born to HIV positive women.

Results

	The overall rate of diagnosed perinatal HIV infection was 2.7 per 100,000 infants up to 1 year of age.
	The average annual rates of diagnoses of perinatal infection during this period were:
	12.3 per 100,000 persons among blacks; 2.1 per 100,000 among Hispanics/Latinos; 1.6 per 100,000 among people reporting other (e.g., Asian/Pacific Islander, Native American) or mixed race/ethnicity; 0.5 per 100,000 among whites.
	The rate of perinatal diagnosis among black infants was 23 times that of whites, while the rate among Hispanic/Latino was about 4 times that of whites.
	However, racial/ethnic disparities narrowed between 2004 and 2007:
	Annual perinatal HIV diagnosis rate for black children fell from 14.8 to 10.2 per 100,000; Annual rate for Hispanic/Latino children fell from 2.9 to 1.7 per 100,000; Annual rate for white children did not change significantly.
	Looking at all children, 69% of diagnoses of perinatal HIV infection occurred among blacks and 16% among Hispanics/Latinos, with lower proportions among whites (11%) -- who make up about two-thirds of the U.S. population -- and people of other or mixed race/ethnicity (4%).
	Considering only infants age 1 or younger, 15% were black, 22% were Hispanic/Latino, 56% were white, and 7% were other or mixed race/ethnicity.

A limitation of this analysis is that it excludes areas that still used anonymous reporting during the study period, including some with high HIV/AIDS burdens such as California, Illinois, and Washington, DC.

An editorial note accompanying the report stated that these disparities are directly related to the racial/ethnic distribution of women with HIV. Heterosexual transmission remains the principal route of exposure for HIV positive women of all races/ethnicities, accounting for 80% of new infections.

Recent studies have suggested that the higher rates of HIV infection among blacks in the U.S. "are related to a number of social factors, such as tight social networks, assortative mixing, and poverty."

In addition, a study of Medicaid enrollees found that black and Hispanic women were significantly less likely than white women to receive prenatal care during the first trimester of pregnancy and made fewer prenatal care visits, thus affording less opportunity for timely HIV testing and early antiretroviral prophylaxis to prevent perinatal transmission. Other studies have shown that black and Hispanic HIV positive women are less likely than white women to be taking antiretroviral therapy before pregnancy, and more likely to have detectable viral load at the time of delivery.

"Primary HIV prevention in women is the best way to prevent HIV infection in children," the note continued. "All women with HIV infection should have reliable access to comprehensive HIV treatment and primary women's health care to optimize their health before pregnancy and receive effective contraception to avoid unintended pregnancy. To eliminate perinatal HIV transmission, all HIV-infected pregnant women must 1) receive a diagnosis of HIV infection before or early in pregnancy, 2) receive prenatal care, 3) adhere to an antiretroviral medication regimen during pregnancy, 4) have a scheduled cesarean delivery at 38 weeks' gestation if viral suppression has not been achieved, and 5) receive antiretroviral medication during labor and delivery. Antiretroviral medication also should be provided to HIV-exposed newborns within the first hours after birth and for the first 6 weeks of life."

"To further reduce perinatal HIV transmission and racial/ethnic disparities, HIV-infected pregnant women, and particularly black and Hispanic women, should receive timely prenatal care, early antiretroviral treatment, and other recommended interventions," the investigators concluded.

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

2/12/10

Reference
Lampe, S Nesheim, RL Shouse, and others. Racial/Ethnic Disparities Among Children with Diagnoses of Perinatal HIV Infection -- 34 States, 2004--2007. Morbidity and Mortality Weekly Report 59(4): 97-99 (Full text). February 5, 2010.